Nuffield Trust: Outdated stereotypes putting off students studying mental health nursing while pandemic pushes more demand on services

Negative perceptions of mental health patients and a lack of understanding about mental health nursing roles are putting people off pursuing a career in this vital field at a time when demand is set to continue growing significantly as a result of the Covid-19 pandemic.

A report from the Nuffield Trust, commissioned by NHS Employers and the Mental Health Network, which are part of the NHS Confederation, warns that despite the unique opportunities to act as a bridge between mental and physical healthcare and continued attempts to promote parity of esteem, the levels of demand to study mental health nursing in recent years looks unlikely to support a sustainable supply of qualified nurses for the NHS.

Laying Foundations: Attitudes and access to mental health nurse education (attached) explores why despite renewed interest in mental health nursing roles, there continue to be barriers to people taking up routes into these careers. It finds:

• Negative stereotypes of mental healthcare continue to exist due to a lack of access to positive exposures and experience of mental health.
• Nationally, there has been a failure to promote the unique and varying nature of mental health nursing. This is often because of the complex terminology used to describe the role, which in turn paints it in an inaccurate or negative light.
• A lack of awareness of the mental health nursing role and the skills involved with the role as a result of absence from mainstream media and a lack of exposure to potential interest at school-leaver age.
• Students on mental health nursing courses are more likely to be male, older and from minority groups than other branches of nursing. This is positive from a diversity and inclusion perspective but to ensure a sustainable supply of new nurses, it will be important to both provide sufficient opportunities for these groups and well as attract applications from wider groups.
• Taxpayer funding to universities for mental health nursing courses is less per student than some other fields of nursing and associated professions.
• Regional provision for some mental health nursing courses is patchy. The number of students accepted in the North East of England – relative to the size of the population – is three times that of the South East, with the latter already struggling with high levels of vacancies in the workforce.
• The government introduced new maintenance grants in 2020. It is too early to understand the impact of these, but they do not appear to be well understood by potential applicants.

In England, mental health nurses account for over a third of the mental health workforce, but even before the pandemic growth in demand for services had outpaced the increase of those in mental health nursing posts.

Since the start of the pandemic there has been increased interest in NHS careers, and applications to mental health nursing specifically have risen by a third. More needs to be done to build on this apparent momentum.

The report makes a series of recommendations, including:

• Ensuring investment is made to promote the valuable contribution that mental health nurses have made already during the pandemic and promote a more accurate and realistic image of the career and benefits.

• Support access to positive personal experiences and exposure to mental health services and staff via sharing good practice on work experience and outreach work.
• Review career pathway and progression for mental health nursing roles, ensuring they are matched with equivalent roles.
• Provide more opportunity to encourage mental health nursing opportunities across the breadth of the population, including different gender, ethnicity and socioeconomic status.

Senior Fellow at the Nuffield Trust, Dr Billy Palmer, said:

"The NHS has made it a priority to bring mental health services onto a level playing field, yet potential recruits to important roles including mental health nurses are being put off by outdated stereotypes and a lack of understanding of the breadth and benefits of these roles.

"The toll of the pandemic is likely to bolster the growth in demand for mental healthcare that we have seen over recent years. But the reality is that the health service is not keeping pace with the number of qualified nurses needed to meet this demand.

"Often, how these roles are promoted does not paint the career in an accurate or positive light. We need to widen opportunities to promote this rewarding career to a much broader section of society.

“Mental health nursing offers the opportunity for a rewarding career, and there are reasons to be optimistic. The pandemic has seen interest in the career grow. This interest needs to be seized upon, given the challenges mental health services will continue to face.”

Rebecca Smith, managing director of NHS Employers, said:

“It’s absolutely vital that the health service must have access to a strong pipeline of talent into mental health nursing. That means taking steps such as reducing barriers to entering the profession, as well as making sure those considering a career in nursing are aware of all the avenues available to them, and in turn, of the range and the rewards a career in mental health nursing can offer.

“Across nursing in England, mental health has the highest numbers of vacancies after acute care. We therefore very much welcome the recommendations in this report and will continue to work with the Mental Health Network and other national bodies to do our part to help rectify the situation.”

Sean Duggan, chief executive of the NHS Confederation’s Mental Health Network and a former mental health nurse, said:

“With estimates that an additional 500,000 people will require support for their mental health in the next two years and with some providers already responding to a 20 per cent increase in demand for their services since the first wave of the coronavirus pandemic, it is deeply concerning that we have such a gap in nursing roles in this sector, both now and for what’s needed in the future.

“Mental health services are doing everything they can to support their patients, but these major workforce shortages need sustained attention and long-term investment from the Government. This includes a national recruitment campaign focused specifically on attracting people into mental health nursing roles, a deep focus on the surrounding issues that may make people want to leave the profession, and supporting local systems to ‘grow their own’ talent.

“Mental health nurses are a lifeline to some of the most vulnerable people in our communities, so with the pandemic continuing to take a toll on the nation’s mental health and wellbeing, this crisis is too important to ignore.”

Notes to editors:

• Case studies from mental health nurses or students are available on request.
• Laying Foundations: Attitudes and access to mental health nurse education is a Nuffield Trust led research report commissioned by NHS Employers and the NHS Confederation Mental Health Network.
• The report is based on an existing literature review, focus groups and a series of interviews.